Health

The human immunodeficiency virus (HIV) is the causative agent of AIDS. Patients with HIV have a reduced ability to fight infection and are more susceptible to developing infections because HIV attacks and destroys the immune system. Diarrhea occurs in 30 to 80 percent of the these patients. Chronic diarrhea of unknown cause in HIV-infected patients is called AIDS enteropathy. The exact cause of AIDS enteropathy is unknown, but gut infections or a direct effect of HIV on the intestines may be involved. To gain a better understanding of AIDS enteropathy, stool samples from 22 patients with HIV infection and chronic diarrhea, and 13 patients with HIV and no diarrheal symptoms were grown in culture to identify bacteria that may be associated with the cases of diarrhea. Fifty percent of the patients with both HIV and diarrhea had gut infections; 25 percent of the infections were due to Mycobacterium avium-intracellulare and the other 25 percent were due to microsporidia. Weight loss was greater in patients who had both diarrhea and gut infection (31 pounds) than in those who had diarrhea without gut infection (13 pounds). Survival was greater for those without gut infection (73 percent still alive) than for those who had gut infection (9 percent still alive). Tissue samples taken from the intestines of all the HIV-infected patients, regardless of the presence of diarrhea or gut infection, showed signs of atrophy (shrinkage). These findings demonstrate that 50 percent of the patients in this study had AIDS enteropathy, while gut infection accounted for the other 50 percent of cases of diarrhea. Further studies will be needed to understand the changes that occur in the intestines of patients with AIDS. (Consumer Summary produced by Reliance Medical Information, Inc.)

Fulminant hepatic failure associated with 2',3'-dideoxyinosine (ddI)

Article Abstract:

One of the newer drugs being used to treat patients with AIDS is 2',3'-dideoxyinosine, or ddI. The most commonly reported adverse effects of ddI are peripheral nerve damage and pancreatitis, or inflammation of the pancreas. A case of severe liver failure with death in an AIDS patient taking ddI is reported. A 36-year-old man with a history of Gilbert syndrome, a mild congenital liver disease, and AIDS took ddI for 15 weeks, and then developed nausea, vomiting, and abnormalities of his blood liver function tests. The ddI was stopped, and a liver biopsy was performed, which showed only mild abnormalities. When the blood tests normalized six weeks later, the ddI was resumed. Three months later the patient had some mild gastrointestinal symptoms of nausea, mild abdominal pain, and appetite loss. His liver function tests were again found to be abnormal. When the liver studies rose to eight times the normal values, the ddI was stopped, and the patient was admitted to the hospital. Within two days, his blood tests showed that he was rapidly worsening, with severe abnormalities of virtually all laboratory studies. The patient died of the complications of his liver failure. An autopsy showed an enlarged and damaged liver. Other cases of mild abnormalities of liver function associated with the use of ddI have been reported, but this appears to be the first death from ddI-related liver disease. Whether the patient's history of Gilbert syndrome, played a role in his liver failure and death is unknown, but no other drugs are known to cause liver failure in people with Gilbert syndrome. Physicians caring for patients with AIDS should be aware of this rare but potentially fatal side effect of ddI. (Consumer Summary produced by Reliance Medical Information, Inc.)

Nicotinic acid is used to treat hypercholesterolemia, an excessive amount of cholesterol in the blood. Nicotinic acid therapy rarely causes toxic effects in the liver, although toxicity may occur after ingestion of more than 3 grams of the drug per day. Adverse effects on the liver include jaundice or yellowing of the skin, pruritus or severe itching, increased levels of serum bilirubin, the yellow pigment in bile, and increased levels of the enzymes alkaline phosphatase and aminotransferase. Some cases of injury to liver cells have been reported. A case is described of a 44-year-old man, who developed fulminant or rapidly developing liver failure after changing dosage forms of nicotinic acid from the ordinary preparation to a sustained-release form. The patient eventually required and successfully underwent liver transplantation. Several lines of evidence suggest that the liver damage was due to the sustained-release nicotinic acid. The patient had used the crystalline form of nicotinic acid without any sign of impaired liver function. The onset of liver failure was closely associated with the start of the sustained-release nicotinic acid therapy. The patient had no signs of viral infection or exposure to toxic agents that may cause liver damage. The mechanism whereby sustained-release nicotinic acid preparation causes rapidly developing liver damage is not known. Although nicotinic acid is effective in treating hypercholesterolemia, patients should be made aware of its potential adverse effects on the liver. (Consumer Summary produced by Reliance Medical Information, Inc.)

Author: Mullin, Gerard E., Greenson, Joel K., Mitchell, Mack C.

Publisher:American College of PhysiciansPublication Name:Annals of Internal MedicineSubject:HealthISSN:0003-4819Year:1989